Coronary artery disease is often characterized by lesions or occlusions in the coronary arteries. This disease may result in inadequate blood flow to the myocardium, or myocardial ischemia, which is typically responsible for complications such as angina pectoris, necrosis of cardiac tissue (myocardial infarction), and sudden death. Drugs and/or modifications in behavior and diet may be used to treat coronary artery disease. Other types of treatment include dilation of coronary arteries by procedures such as angioplasty, laser ablation, atherectomy, catheterization, and implantation of intravascular stents. In more severe cases, coronary bypass surgery may be required when other methods of treatment are impossible for a variety of reasons or ineffective in clearing the occluded artery.
Coronary artery bypass graft (CABG) surgery is one type of coronary bypass surgery. In CABG surgery, a blood vessel is obtained from another portion of the patient's body and used to create a bypass conduit around the occlusion to restore proper blood flow through the coronary artery. A common blood vessel for use in such procedures is the saphenous vein which is located in a patient's leg. The saphenous vein is preferred because it is found close to the surface of the skin and requires minimal dissection to harvest, or extract, from the body.
The blood vessel selected for extraction typically has a plurality of vessels branching from the blood vessel. Dissection of branching vessels from the blood vessel often is required to ultimately extract the blood vessel. To dissect the branching vessels, each of the branching vessels must be severed with a cutting device and burnt shut, or cauterized, to stop the blood flow through the branching vessel. Additionally, once the surgeon determines the desired length of the segment of the blood vessel required for the bypass procedure, the ends of the blood vessel segment must be severed and cauterized as well before the blood vessel segment is extracted from the patient's body.
The extraction procedure can range from minimally to highly invasive. A highly invasive extraction procedure typically requires an incision long enough to extract the blood vessel segment having the desired length. Such an incision can result in severe post operative pain to the patient and often can lead to long term or permanent numbness of the extraction site.
A minimally invasive extraction procedure, e.g., for a saphenous vein, typically begins with a relatively small incision formed in the patient's leg to create an opening into the patient's leg at the first end of the saphenous vein segment. Working under the patient's skin, the surgeon then uses multiple tools to sever and cauterize branching vessels and connective tissue to isolate the saphenous vein segment. After sufficient isolation, a second relatively small incision is formed in the patient's leg to create an opening into the patient's leg at the second end of the saphenous vein segment. The first and second ends of the saphenous vein segment are then severed and cauterized to allow the surgeon to extract the saphenous vein segment from the patient's leg.
The number of steps, and the resulting number of tools, required to extract a blood vessel can make performing the minimally invasive procedure difficult for an inexperienced surgeon. The amount of connective tissue present, the number of branching vessels, and the length of the required segment of the blood vessel can make the procedure highly time consuming.
Thus, it would be desirable to provide a medical device to allow a surgeon to isolate a segment of the blood vessel using a single instrument to avoid exchanging multiple instruments during the procedure. Further, it would be desirable if such medical instrument is capable of grasping and/or cauterizing branching vessels and/or connective tissue independently of any cutting action to allow a surgeon to more effectively and efficiently navigate the device under the skin along the length of the blood vessel.